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Mad Tourist Disease

Two cows are talking, and one says, “You know, Bob, I’m worried about this ‘mad-cow disease’,” and the other cow answers…

There are about 10 endings to this joke and my favorite is “and the other cow answers, ‘Holy crap, a talking cow!’”

My second-favorite, and more relevant to this article I’m trying to write, is “and the other cow answers, ‘Well, that shouldn’t affect us chickens.’”

When I talk to people about visiting South-east Asia (where I spend a lot of time), they frequently ask about two diseases: yellow fever and malaria. I feel like I’m the Second Cow from the joke: I’m not worried about it.

Yellow fever has killed millions of people — including Walter Reed, the heroic researcher who deliberately allowed an Aedes aegypti mosquito to bite him, conclusively (and fatally) proving how the disease was acquired — and sickened hundreds of millions more, but virtually all of those victims had one vital thing in common: they weren’t in Asia.

Yellow fever, yellow jack it’s called, is a disease of Africa and South America. It isn’t any more common in Jakarta than in New York. Tourists in Asia who worry about yellow fever are like real chickens who worry about mad-cow disease — except there really are worried tourists, and most chickens look pretty relaxed.

Concern about malaria is a little more realistic. Malaria is found in Southeast Asia. People do get it. You won’t, even if you visit SEA, but people do. Malarial Anopheles mosquitoes live in swampy, low-lying areas; tourists, by and large, prefer the beach or the mountains.

Still, it isn’t completely impossible. You get lost on your way to the beach, a mosquito gets lost on its way to the swamp, there’s ominous music, the two of you meet, and boom, you’re infected.

So? Malaria is unpleasant, aches and chills for weeks, but it isn’t going to kill a healthy adult with access to First-World medical services.

Which is why I find the continuing popularity of anti-malarials like doxycycline puzzling. The disease, in the million-to-one chance you get it, is unpleasant, but not enough to warrant (a) expensive medication that (b) might not work (there are many different strains of malaria, and I’m sure that the anti-malarial I pick won’t work on the strain I catch), but (c) does make you sick to your stomach whether it works or not.

The situation is far more dire for people who actually live in tropical Asia. A lot of them are poor, for one thing. They can’t afford doxycycline, and they don’t get to spend a lot of time at the beach or hiking in the mountains. They often live and work in agriculture areas that, to a mosquito, look a lot like swamps: hot, humid, lots of standing water to breed in. Worse, the victims often cannot afford medical care, if it’s even available, once they do get sick. Malaria kills 700,000 people a year, mostly in Africa but also in Burma, Laos, and Cambodia.

Of course, the kind of person who contracts malaria while working in a rice paddy probably isn’t spending a lot of time reading culture blogs; since you are reading this, you probably aren’t at risk.

But there are far more serious diseases out there, for locals and tourists alike.

There’s Japanese encephalitis, for one thing. JE can cause brain damage, coma, mental retardation, and death. (Isn’t it weird that mental retardation seems scarier than death?)

There’s dengue, a disease so painful it’s nicknamed “bonebreak fever”. It can kill you too. And the Aedes mosquito, which carries dengue, flies around all day, unlike the Anopheles mosquito, which carries malaria and only comes out at twilight.

The really wonderful thing about JE and dengue is there’s no treatment if you do get catch one. You just lie in bed and suffer. There’s a vaccine intended to prevent JE, but nobody knows how well it works, and no vaccine at all for dengue.

So why do tourists in Asia worry about yellow fever, which they cannot get, and malaria, which they probably won’t get and almost certainly won’t die of, but ignore JE and dengue?

I think it’s just cultural. Westerners have heard of malaria and yellow fever. The Panama Canal, Stanley and Livingstone, we’ve heard of malaria and yellow jack, so we worry about them. Japanese encephalitis sounds like something Japanese people get. Dengue doesn’t even sound like a disease. Maybe a Chinese swear-word.

The truth is, though, for all practical purposes, there is a prevention against all these diseases, almost totally effective: n,n-diethyl-meta-toluamide. DEET. It actually doesn’t affect the diseases directly at all, it just smells bad to mosquitoes. Go to a sporting-goods place like REI or Sports Basement (or to any 7-11 if you’re already in the tropics), get a big bottle of it (25% solution is best: most people’s skin would be irritated the 100% kind), and spray yourself whenever there is the slightest chance of meeting a pesky moskie. No mosquitoes, no mosquito bites; no mosquito bites, no fever.